A physiatrist contacted me today asking about the average number of vacation days for a senior physiatrist. My guesstimate is about 6 weeks. As I said to him, the number of vacation days as a benefit are often negotiable especially when you are a senior physiatrist and not tied to a particular number.
There is not alot of information available on this subject. I couldn’t find any information specific to career level and the number of vacation days. In general across all levels, an article from the August 27, 2018 New England Journal of Medicine says that Paid Time Off benefits are getting more generous but less flexible. “PTO has become much more clearly defined in recent years,” Ms. Caldwell said. Organizations today are stating the exact number of permitted days off (four to six weeks annually is the common range now), defining what constitutes paid vs. unpaid leave, and being firm on what happens with accrued leave that isn’t taken.”
A sampling of some of the vacation times of positions I’m representing but are not specific to senior physiatrists include 6 weeks an inpatient position in NH), 4 weeks (an interventional position in MA), 4 weeks (a Medical Director, Rehab position in MN), 6 weeks (an interventional position in MN), 3 weeks (inpatient in NV), and 4 weeks in RI (inpatient, consults and interventional).
Physiatry Recruitment in Corona Virus Times
How Covid Has Changed the Employer’s Physiatry Search
Covid requires some tweaking of the employer’s search for a new physiatrist. First, less employers are hiring PM&R doctors during Covid. So hats off to those employers who have the financial ability to add a physician medicine and rehabilitation physician! If you’re seeking a new physiatry graduate, it should be easier to recruit from the standpoint of supply and demand although as usual many PM&R residents go onto fellowships. Hiring an experienced physicial med and rehab doctor may be easier or more difficult. If you’re in an urban area that has been hard hit by Covid, there probably is a greater supply of physiatrists. If you’re in a suburban or rural area, I think most physiatrists are deciding to stay put until Covid is over.
In most ways, the physiatry recruitment process will be more difficult. There is an AAPMR Job Fair but it will be virtual so who knows if it will be more or less effective than in person. As most of the process will be by phone and electronic, it maybe more time-consuming and most definitely will require more discernment to identify if the PM&R candidate is right for your practice. The travel difficulties will make the site visit more important because follow-up visits will most likely not occur during Covid. Please make sure that you plan it well to include everything and everyone that are important to you and the physical medicine and rehabilitation candidate’s ultimate hiring decision. Farr Healthcare, Inc. can help greatly in this process.
The Impact of Covid on Physiatry Recruitment
I hope you, your families and your practices are doing as best as can be expected during these difficult times.
Physiatry recruitment continues in these Corona Virus times! Positions may not actually start until after the world comes back to life but some entities continue to want to add physiatrists. These are mostly national rehab entities and some private practices. On the other hand, most interventional practices have put their openings on hold.
Recruitment continues. Some of the hiring entities are meeting with the interested doctors via Zoom meetings. Entities understand that the recruitment process to include contract negotiation and credentialling takes quite awhile so they continue to recruit so as to not lose time.
I have received some calls from physiatrists for non-clinical or telemedicine positions but unfortunately I don’t have any such openings. All of the positions I represent are clinical positions.
Be well!
New Medicare Proposal Would Allow Non-Physician Practitioners to Perform Some Inpatient Work Done by Physiatrists
This proposed rule would update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2021. As required by statute, this proposed rule includes the classification and weighting factors for the IRF prospective payment system’s case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2021. We are proposing to adopt the most recent Office of Management and Budget statistical area delineations and apply a 5 percent cap on any wage index decreases compared to FY 2020 in a budget neutral manner. We are also proposing to amend the IRF coverage requirements to remove the post-admission physician evaluation requirement and codify existing documentation instructions and guidance. Additionally, we are proposing to amend the IRF coverage requirements to allow non-physician practitioners to perform certain requirements that are currently required to be performed by a rehabilitation physician.
For more information visit https://www.federalregister.gov/documents/2020/04/21/2020-08359/medicare-program-inpatient-rehabilitation-facility-prospective-payment-system-for-federal-fiscal
Before You Sign That Physiatry Contract – Consider the Repayment of Bonuses
Before you sign a contract, it is necessary for physicians to minimize the amount they may be required to repay for bonuses.
In the case of exiting a contract, be aware of the requirements to repay sign-on bonuses, residency stipends, relocation reimbursements, or student loan assistance. There are often constraints built into the contract in order to incentivize the physician to remain at the same practice for a number of months or years.
Additionally, know when you typically receive salary and RVU or productivity bonuses so that you don’t miss out on receiving this compensation which you have earned before you exit.
This article was contributed by PhysicianThrive, https://physiciansthrive.com
RVU’s for Physiatry – Should We or Shouldn’t We!
The following advice was provided to the question of whether a practice should use RVU’s as a basis for payment to a new doctor:
RVUs correlate to CPT Codes, which correlate to income.
RVUs are good for physiatry employees whose PM&R practice has low-reimbursing insurance carriers, like Medicaid. In this case, the lack of reimbursement will not unfairly penalize the physical medicine and rehabilitation employee who is working hard, but does not receive correspondingly high reimbursement. In other words, their RVUs will be high, but their reimbursement will not be as high.
But, all things being equal, RVUs translate to reimbursement.
RVUs only confuse the physiary employee. Using them is awkward, not well-understood, and confusing.
Better to stick to dollar incentives, which is understood by all.
This information was contributed by Bruno Stillo, CPA, MBA, Physiatry Billing Specialists, 800-835-4482,
www.physiatrymedicalbilling.com
physiatrybillman@aol.com
Partnership Terms for Physiatry
A doctor recently asked me about how to set up partnership terms. I don’t have much experience with this subject but here’s some research I did.
First, you need to determine your practice’s financial value of your practice. Your accountant can help. Once a price has been set, the new partner either pays the full amount up front or pays it over a few years, with or without interest. While the new partner receives no tax deduction for the investment, the selling owners must report any gain on the sale of the stock (the portion that they are selling to the new partner) as a capital gain.
The value of the practice is a major element of the buy-in agreement. Three main
factors – tangible assets, accounts receivable, and goodwill – are used to determine the value
of the practice and therefore the physician’s share or buy-in amount. The tangible assets are
the easiest to determine because they include cash, furniture, equipment, and other items with
measurable cash value. The accounts receivable are monies owed to the practice for services
already rendered. Goodwill is the value of the practice’s expected future earning power.
Theoretically, determining the amount that should actually be paid for the buy-in involves
multiplying the sum of these three values by the proportion of ownership interest that the new
doctor will receive in the practice. However, the absence of any single, reliable methodology for
calculating goodwill complicates the matter considerably.
There are several ways to go about determining buy-in value. Some practices pay for a
full-blown practice valuation by an outside consultant each time a partner buys into the group.
Even such “professional” valuations are imprecise, however, since there is no single generally
accepted methodology for calculating practice value. Thus most valuators use several
methodologies to construct a range of value. Other practices use crude rules of thumb or
comparable practice sales data to calculate goodwill. Some practices use a pre-determined
amount and phase in the buy-in over several years through salary reductions (“sweat equity”).
Some practices choose to ignore goodwill and tangible assets and instead base the value solely
on accounts receivable. Some include all tangible assets and accounts receivable and leave only
goodwill out of the formula.
Taken from https://www.acponline.org/system/files/documents/running_practice/practice_management/human_resources/income_dist.pdf
Physiatrists, Don’t Forget the Receptionist!
One way to find out more about a practice is from the receptionist or any staff member. They will often provide honest information invaluable to assessing the true nature of the practice culture on a day-to-day basis. Just a basic question like how long have you worked here can tell you alot. If the front desk person hasn’t been there awhile, it could be a key to a bigger picture about the rest of the staff and their turnover. And, it could be an indication that the practice doesn’t have good patient-office relations which could lead to less patients than other practices attract. Other basic questions are: What do you like best about working here? What are your hours? (If the answer is longer than the posted hours, it can indicate the hours you might work.) What do you think of the patient charting system?
How do I Know if a Physiatry Practice is Busy Enough to Add a New Doctor?
A physiatry resident recently asked me this question. It reminds me that on occasion I’ve been told by PM&R doctors that the reason they’re calling me to find a new position is because the practice they’re at isn’t busy enough to support them. Here are some ways to possibly identify beforehand whether a physical medicine and rehabilitation practice you’re considering joining is busy enough to support you:
- Ask why they’re adding a new physiatrist.
- Make sure there’s a salary as opposed to an incentive based compensation. Also, that the salary is the major chunk of your compensation as compared to the incentive portion.
- Ask who the referral sources will be. Are they already servicing these referral sources? How do they expect extra work from them for you?
- Find out the reputation of the PM&R practice. Again, if you’re not familiar with the area, then this might be difficult to do.
- Ask about the physiatry turnover at the practice. When was the last time they added a PM&R doctor? If it was recently, then maybe they can’t support another doctor.
- Ask about the practice’s financial situation.
- Ask for the books. This is a simple, yet often times, difficult request to make.
- Survey the waiting room. Is it busy?
- What marketing are they doing or plan to do?
- Ask how long the waiting list is for an appointment?
- Ask the practice what are their growth plans and vision for the future.
What’s New In Physiatry?
Physiatry has seen trends in the favored services. For example, EMG’s were a favorite 20 years ago, then interventional, then subacute. New graduates are now gradually returning to an interest in inpatient, TBI, and SCI .
A newer trend in physiatry is the interest of private equity firms in physiatry. Some private equity firms favor physiatry by the service provided. For example, some firms affiliate with physiatrists who do subacute work while some favor those who do general outpatient or interventional work. If you have an interest in affiliation/acquisition, please contact me at farrhealth@comcast.net, 888-362-7200, 717-232-7211 cell phone.
2020 New Year’s Resolutions for Physiatrists
Everyone is talking about New Year’s Resolutions! What is your physical medicine and rehabilitation business resolution for 2020? You might consider these PM&R resolutions:
- Find a new physiatry job. Farr Healthcare, Inc. can help you with this!
- Increase your bottom line
- Pursue avenues towards physical medicine and rehab practice acquisition as many practices are being acquired these days. Farr Healthcare, Inc. has information about some possibilities.
- Change the practice’s incentive arrangement
- Add new information technology to the practice
- Do more marketing
You have to ask yourself what is your true desire for the future. Whatever it is, the experts say it’s important to set goals and priorities to accomplish the resolution. In these days where many doctors feel like they’re losing control, making a New Year’s Resolution and accomplishing it will make you gain control.